The specificity of serological tests for Lyme borreliosis is impaired by cross-reacting antibodies. In order to select antigens for more specific tests, specific and cross-reactive proteins of Borrelia burgdorferi must be identified. Therefore, to analyze cross reactions of Borrelia burgdorferi with other bacteria, rabbit immune sera against heterologous bacteria (Borrelia hermsii, Treponema pallidum, Treponema phagedenis, Leptospira interrogans (serogroup grippotyphosa), Neisseria meningitidis, Haemophilus influenzae, Yersinia enterocolitica (serotypes O3 and O9), Campylobacter jejuni, Listeria monocytogenes O1, Pseudomonas aeruginosa, Escherichia coli, Salmonella typhimurium, Shigella flexneri and Legionella micdadei) were examined by Western blot using Borrelia burgdorferi as antigen. Broad cross reactivity was shown for Borrelia proteins of the 60-75 kDa range. Other broadly cross-reacting proteins were at the level of p40, p33 and two proteins in the range of 20 kDa. Some of the cross reactions were eliminated by absorption of the sera with Treponema phagedenis. The absorbed antibodies were directed mainly against bands at the level of p33 and bands of the 60 to 75 kDa range. Showing the lowest potential for cross reactivity, p100, p41, OspA and pC seem to be the most suitable antigens for serodiagnosis. In contrast to p100 and OspA, however, p41 and pC showed cross reactivity with immune sera against bacteria not belonging to the genus Borrelia.

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Skin biopsies of 36 patients with erythema migrans and acrodermatitis chronica atrophicans (ACA) before therapy and those of 8 patients after therapy were examined for Borrelia burgdorferi DNA by PCR. Skin biopsies of 27 patients with dermatological diseases other than Lyme borreliosis and those of 10 healthy persons were examined as controls. Two different primer sets targeting 23S rRNA (PCR I) and 66-kDa protein (PCR II) genes were used. PCR was performed with freshly frozen tissue (FFT) and paraffin-embedded tissue (PET). For FFT specimens of erythema migrans, 73% were positive by PCR I, 79% were positive by PCR II, and 88% were positive by combining PCR I and II. For PET specimens, PCR was less sensitive (PCR I, 44%; PCR II, 52%). For FFT specimens of ACA, PCR I was positive for two of five patients and PCR II was positive for four of five patients. B. burgdorferi was cultured from 79% of the erythema migrans specimens but not from any of the ACA lesions. Elevated B. burgdorferi antibodies were detected in sera of 74% of erythema migrans patients and 100% of ACA patients. All urine samples were negative by PCR II, whereas PCR I was positive for 27%. However, hybridization of these amplicons was negative. Sequencing of three amplicons identified nonborrelial DNA. In conclusion, urine PCR is not suitable for the diagnosis of skin borreliosis. A combination of two different primer sets achieves high sensitivity with skin biopsies. In early erythema migrans infection, culture and PCR are more sensitive than serology.

In 206 DD patients further disease progression was stopped in most patients. Radiotherapy proved to be well-tolerated, successful and satisfying for the patients.

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